RES 054 Draft 01 2012-2014 - Laserfiche WebLink

Home

Customized Commercial & Industrial Incentive Application Hawaii Energy Effective July 1,2012;subject to availability of funds. Hawaii Energy is a ratepayer-funded conservation and efficiency program administered by SAIC under contract with the Hawaii Public Utilities Commission serving the islands of Hawaii,Lanai,Maui,Molokai and Oahu. THIS SECTION MUST BE FILLED OUT COMPLETELY BEFORE SUBMISSION Utility Account Holder's Name: Project/Building Name: Contract Number: 0 HECO County of Hawaii -Traffic Division LED Implementation 301501011789 Installation Address: City: State: Zip: (Legacy)Account Number: ®HELCO Waimea, Kinoole, Kilauea, Hilo Hilo HI 96720 ----'---- ---DMECO Account Holder Contact: Title: Phone: Email: Ronald L.Thiel,P.E. Division Chief 808-961-8341 dpwtrf©co.hawaii.hi.us Mailing Address(if different from above): City: 108 Railroad Ave. O State:I-11 zip:96720 Federal Tax ID of Payee: Tax Status of Payee: Application is for: 99-6000567 ['Corporation ❑Non—Corporation IN Existing Building (Complete Third Party Payment Section if payment is not to Utility Account Holder) EI Government 0 New Construction Incentive Check to be paid to this Payee: 0 Account Holder at Service Address ©Account Holder at Mailing Address 0 Trade Ally 0 Third Party Estimated Project Costs Anticipated Project Dates Materials:$3,140.10 I Total(including labor):$110,819.88 Start:05/22/2012 Completion:11/18/2012 Authorization for incentive Payment to Third Party Payable To: Contact: Phone: Email: Mailing Address: Trade Ally/Installing Company,(If Applicable) Company: Contact/Title: Phone: Email: Mailing Address: Project Description BASE CASE: The Base Case is the"Standard Efficiency replacement alternative and/or the Code-Compliant design.Describe the Base Case design or equipment and provide the make,model,single-line diagrams,performance curves/monitored data.Existing equipment will be accepted for the Base Case analysis only if it is replaced prior to the end of its useful life. C&W KSO4 Series Star Friendly Luminaire - LED installation on Hawai'i Island, switch from low pressure sodium street lights to light emitting diodes islandwide conversion. ENHANCED CASE: The Enhanced Case is the High-Efficiency"replacement alternative and/or the Above Code-Compliant design.Describe the Enhanced Case design or equipment and provide the make,model,single-line diagrams,performance curves/monitored data. SIGNATURE I have read, understood, agree to the Terms and Conditions,the application procedure detailed on this application and that I shall forward the Tax Form W-9 to Hawaii Energy upon request. I further understand that Hawaii Energy Program will mail to the payee and report to the IRS all incentive payments on the Internal Revenue Services Form 1099. I am further advised to consult my tax advisor concerning the taxability of the incentive. Hawaii Energy Program is not responsible for any taxes that may be imposed on me or my business as a result of my receipt of this incentive. PRINT NAME: RONALD L THIEL TITLE: TRAFFIC DIVISION CHIEF SIGNATURE: DATE: 1 0t2 HAWAII ENERGY App#: kW: kWh: $/kWh: USE ONLY: Approved Amount: $ 1g+: 2nd: 3rd: :Worksheets D Data Sheets Dlnvoices 0 W-9 Form Questions:Call the Business Program 839-8880(Oahu)or toll free at 877-231-8222•www.hawaiienergy.com PY2012C&I 0712-3